Workplace health promotion programs are intended to reduce medical expenditures; however data are lacking to show such savings. This project will study the relationship between modifiable personal risk factors and high-cost use of health care in a population of textile workers and their dependents. The theoretical model holds that, all other things being equal, increasing risk factors leads to depressed health status, which leads to increased utilization of services and to higher expenditures. Characteristics of individuals, the work situation and the health care system will be assessed as potential modifiers or confounders of the theorized relationship. Specific questions to be answered in the population are: (1) What types of utilization are associated with high cost care? (2) What characteristics of individuals (including health status and risk factors), employment or health services are associated with high cost care? (3) Which characteristics are associated with increased utilization? and (4) Which are associated with poor health status? This is a one year period prevalence study of health care costs and utilization in relation to risk and other factors. It uses an industries' centralized insurance claims records from approximately 20,000 employees and 30,000 dependents for cost and utilization data. Employee records provide demographic and identification data. A questionnaire survey of six representative plants (n approximately 3000) will provide health status and risk factor data (cigarettes, alcohol, exercise, seat belts, stress, etc.). Multivariable analyses will assess the significant correlates of poor health status and high cost use. The results will guide a discussion of the relevance of prevention programs for improving health status and containing health care costs in the industry.